Cancer deaths wane in Monterey County

Mortality rates fall across all ethnic lines

Jan. 9, 2014

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Wading through the labyrinth of cancer data for Monterey County can be an exercise in contradictions. But one trend is clear: Fewer county residents are dying of cancer than at any time in the past decade, according to a just-released assessment by the Monterey County Health Department.

One of the most startling data sets shows that where you live in the county can be an indicator of what your chances are of dying from cancer. The two major causes of death locally are heart disease and cancer. Overall heart disease is the No. 1 killer, claiming 25 percent of all deaths, while cancer is a close second at 23 percent. Combined they make up nearly half of all deaths in the county.

But there are exceptions. In northern Monterey County, cancer takes a greater toll than coronary-artery disease. In fact, the mortality rates there are flipped from the county average. Ditto in southern Monterey County, but only by a smidgeon — cancer claiming 22 percent of deaths and heart disease comprising 21 percent.

Higher rates of deaths from heart disease in Salinas and on the Peninsula are what tip the scales to make coronary-artery disease the most efficient killer.

But wouldn’t age demographics throw off the accuracy of the data? If certain communities are made up of older, retired residents, shouldn’t those be the areas with higher death rates from either cancer or heart disease? After all, all men will develop prostate cancer if they live long enough, according to Stanford urologist Dr. Thomas Stamey.

The short answer is no, according to Patricia Zerounian, the accreditation coordinator and an analyst with the Health Department. Zerounian played a key role in assembling the Monterey County 2013 Health Assessment, which was presented to the Board of Supervisors Tuesday by Zerounian and colleague Krista Hanni, the Health Department’s Planning, Evaluation and Policy Manager.

Zerounian explained that the data are “age adjusted,” meaning more statistical weight is given to younger people who succumb to cancer than is given to the elderly.

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“No one would be surprised if your time is up at 80,” Zerounian said. “But you don’t expect someone to die from cancer at 15 or 25.”

Consequently, those who do are given more statistical weight to balance out the overall rate. Age-adjusted cancer mortality trends show that there has been a marked per-capita decrease between 2001 and 2010 across gender and all ethnic lines.

One seemingly contradictory slice of data shows that while cancer is killing fewer people, some data point to increases in diagnoses of cancer. For example, age-adjusted prostate cancer incidence rates significantly increased among Latinos from 2001 to 2010, according to the assessment.

So how can we be both lowering death rates while the incidence rates of at least one particular cancer are increasing?

“Screenings,” said Phillip Williams, director of the Comprehensive Cancer Center at Community Hospital of the Monterey Peninsula. “Screening helps to identify more cases, so higher incidences could be because we are looking more.”

But the screenings themselves aren’t bulletproof. Prostate screens are conducted with a digital-rectal exam often in tandem with a blood test looking at levels of what’s called prostate specific antigen, or PSA. Men want to keep that level under 4.0, according to the American Medical Association. PSA is a protein created by prostate gland cells, and, generally speaking, the higher the amount of PSA in the blood the greater the indication that something is going on in the gland.

But it isn’t necessarily cancer. Urinary tract infections, prostate inflammation, an enlarged prostate and even having sex before an exam can spike PSA levels.

Williams explained that the PSA test is just one tool in the toolbox that could indicate further testing is needed. If a PSA level is high, say 4.0, but it doesn’t move over time, the best approach may be to do nothing and just watch it closely. Whereas a man that has had a 1.8 PSA consistently over several years and then spikes to 4.0 could require more immediate additional testing.

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But mammograms, PSA tests and other diagnostic tools for cancers need to be sought out to provide any benefit. The health assessment indicates that in 2009, fully 45 percent of Hispanic women reported never having had a mammogram or any breast cancer screening, comparing unfavorably to only 17 percent of white women who reported never having breast cancer screenings. The reasons could be cultural or socioeconomic, but health care providers are adamant that screenings are critical to catching cancers early, a significant indicator of a more positive outcome for the patient.

That begs the question of why are cancer mortality rates going down while some incidents are going up and screenings are underutilized in some demographics?

Both Williams from the CHOMP Cancer Center and Zerounian with the Health Department point to medical advances between 2001 and 2010 that are extending lives of cancer patients. But it needs to be noted that in mortality rate data, the measurements are conducted in a window of time; in this case from 2001 to 2010. New drugs and therapies don’t always “cure” a patient, rather makes it a more chronic condition that can still lead to death. For example, if a patient was diagnosed in 2005 with cancer, but new therapies and protocols extended that person’s life until 2011, that death would not appear in mortality data from 2001-2010.

Still, increased surgical skills and more accurate radiation therapies are extending lives, as well as new pharmaceuticals that can now treat cancers that a decade ago were not treatable. One such advance is immunotherapy. One of the problems with cancer cells is that they contain an individual’s own genetic material, so the body’s immune system does not recognize it as a foreign invader. But new immunotherapy can allow antibodies to attack the malignant cells.

This “targeted therapy” zeroes in on proteins on the surface of the cancer cell, called protein expression, instead of the genetic makeup of the cell. These therapies along with enhanced conventional therapies seem to be working, at least here in Monterey County.

Dennis L. Taylor writes about health for The Salinas Californian. Follow him on Twitter @taylor_salnews.